Factors Associated with Chlorhexidine Use for Umbilical Cord Care in Rural Bangladesh: Secondary Analysis of BDHS 2022

Abstract Background Chlorhexidine (CHX) is an effective antiseptic recommended for umbilical cord care to prevent neonatal infections and mortality in low-resource settings. However, its use remains limited in rural Bangladesh. This study aimed to identify factors associated with CHX use for umbilical cord care among rural births in Bangladesh. Method A cross-sectional secondary analysis was conducted using Bangladesh Demographic and Health Survey (BDHS) 2022. The study sample consisted of 1340 rural live births with complete data on CHX use and key covariates. CHX use was defined by maternal report of CHX applied to the umbilical cord after birth. Chi-square tests were used to assess associations with maternal, household and healthcare characteristics. The analysis included survey weights, clustering, and stratification. Outcome Only 14% of mothers reported applying CHX to the umbilical cord, while 86% did not. CHX use was significantly associated with maternal education (p = 0.029), household wealth (p = 0.030), husband’s education (p = 0.007), place of delivery (p < 0.001), skilled birth attendance (p < 0.001), newspaper exposure (p = 0.011), and television exposure (p = 0.016). CHX use was higher among mothers with secondary or higher education, those delivering in health facilities, and those attended by skilled birth attendants. Among deliveries attended by skilled birth attendants, 66% involved CHX use compared with 34% without skilled attendance. Conclusion. Use of CHX for umbilical cord care still very low among rural births in Bangladesh. Maternal education, household socio-economic characteristics, place of delivery and skilled birth attendance are significant factors associated with CHX uptake. Strengthening availability of CHX, training of health workers, counseling during antenatal and postnatal care and community-based interventions may be useful to improve equitable adoption of recommended cord-care practices.